C-sections 'a rational choice'

[AtheneNoctua]

I couldn't agree more.

news.bbc.co.uk/1/hi/health/8057785.stm

That's no say everyone should have one. Just those who want to.

"The fact is that my body didn't want to do what was being asked of it at that time, and I ended up with a section, and it was wonderful."

Well - a c-section is going to be 'wonderful' if a vaginal birth can't be achieved. What other way is there out of the situation?

"And so it pisses me off when people start trotting out all this natural is best stuff. Not for everyone it isn't, no."

Nobody is saying that a vaginal birth is 'best for everyone'.

However, there's clear evidence that women who have no medical need of a c-section, as a group, have better health outcomes from vaginal birth and are less likely to die or have serious health problems arising from the birth.

Within that group there will be women who attempt a vaginal birth who will end up needing a c-section, and a small number of women who will achieve a vaginal birth but end up with health problems that are more upsetting to them than those they are likely to have experienced after a c-section.

Problem is that we have no good way of identifying who these women are.

We also have an over stretched maternity system that makes poor outcomes from vaginal births more prevalent than they ought to be. Compared to a vaginal birth where a woman has poor care from an overworked midwife, a controlled and scheduled c-section is often going to feel like a better experience.

But the answer to that isn't 'let's just have more c-sections'. The answer to that is 'let's give all women appropriate and safe care in labour so that fewer of them end up feeling they would have been better off having a c-section'.

Cote can't understand why anyone wouldn't want to deliver their baby abdominally.

I have witnessed c-sections and know many people who have had them. I know enough about them to know that I don't want one - even when faced with complications that might have made c-section a logical choice for some people.

Would also want to point out BBB, that as we have discussed on this thread, there are plenty of women out there who have not experienced a normal vaginal birth, who know they don't want one! I haven't experienced a c-section, but I know enough about them to know I would not want to deliver my baby this way, unless there was no other option.

"Well - a c-section is going to be 'wonderful' if a vaginal birth can't be achieved. What other way is there out of the situation?"

I mean it was a relaxing, pain free and pleasant experience with an easy recovery. It was a good way to give birth. A lot of women who have EMCS find it a terrible exerience, despite the fact they had no other choice. it is not a wonderful experience for everyone. It was for me.

Mind you a lot of people I know have been traumatised by their natural birth experiences. It's about 50/50 and you take pot luck as far as I can see.

Gaby what are your views on people who have had one CS automatically being offered another, even if there are no medical reasons for it?

I'm finding this discussion extremely interesting.

I am a regular but easily identifiable so have namechanged to avoid discussing my birth options with everyone who knows me!

I am pg with my second and planning an elective section this time. There is no medical reason at all.

However I had a horrendous time first time around. Labour was horrifically long, there were a catalogue of errors, mismanagement, bad decisions and poor treatment throughout the process, including poor management of a separate non-serious but relevant medical condition I have. I have also had other significant problems with past care leading to a major lack of trust with NHS care.

As a result I am having baby no2 at a different hospital and have asked for a c-section. This is mainly because I feel I must do everything I can to avoid anything remotely similar to my last experience happening, including having more control over what's happening than I did last time.

I had my appointment with the consultant last week. Based on what I've read on here I fully anticipated a struggle to get my section as there is no medical reason for it. After what happened last time I really could not face weeks of uncertainty and arguments with people to get what I wanted agreed, so I decided that if at any point I felt it was going to be a struggle/too stressful, we would consider going private.

However there was no problem at all. Unfortunately I dissolved in tears as soon as I started trying to talk through my last experience. The consultant was horrified by it all and began to talk about people I could meet and things they could do to prevent similar problems this time. He also quite rightly and logically pointed out that second labours are very unlikely to be so difficult anyway especially given closer management following my history.

However I said given everything I would prefer to have a section. He understood completely, and I felt gave a very balanced opinion. He outlined the risks of c sections, both major and minor, including the actual numerical risks, rather than just how much higher than VB. He also emphasised that the risks for elective sections are different from emergency sections and should not be lumped together.

He emphasised that he had no agenda in getting me to do either, but given there was no actual medical reason he would recommend I meet two individuals to talk through problems last time and how they could be managed in the event of a VB. I said that I am happy to talk to people and even might change my mind but want to avoid stress and argument should I not.

He wrote on my notes that I would meet these people but, should I still want a section when we get to 32 weeks, I could have one.

I now feel reassured. I am comfortable that there will be no argument or stress about my choice. Because I know that I feel I can go into my next appointments and discuss a VB with a genuinely open mind, rather than having to 'firm myself up' for a struggle against an onslaught of 'natural is best'.

As a result, I may change my mind, but I will enjoy my pregnancy more and feel more relaxed about the birth knowing I have a genuine choice and will receive full information about both with no pressure.

A fully informed choice is the way to go. My choice will be fully informed and because I know it will be a genuine choice, I am more prepared to consider all the options presented to me.

starlight, yes all the births I attended I was there pretty much from the start. Popping in at the end to catch the head is frowned on these days I think. In fact, as the midwives were generally looking after more than one woman at a time, I probably spent more time with the women I observed than their midwife did.

Gaby: you say that more women would die in chilcbirth if the CS figures rose. Is this the case in Brazil, do you know (or does anyone know)? Is maternal morbidity higher there?

csectionthistime i believe that your situation this time around has been handled as well as it possibly could have been and am pleased that you have been given both the choice and offered support to talk through your previous experience.

Absolutely BigBella. It's early days yet obviously, but it has gone some way to restoring my faith in the NHS, including in its ability to handle a potential VB better should I end up going that way.

"Gaby what are your views on people who have had one CS automatically being offered another, even if there are no medical reasons for it?"

The chances of poor outcomes with a vbac are higher than with a vaginal birth where there is no previous scarring. Also, the chances of someone needing an emergency c-section are also higher with someone going for a vbac than for a birth where there has been no previous section. This makes the cs 'vs' vb issues different for someone considering a vbac.

"Gaby what are your views on people who have had one CS automatically being offered another, even if there are no medical reasons for it?"

The chances of poor outcomes with a vbac are higher than with a vaginal birth where there is no previous scarring. Also, the chances of someone needing an emergency c-section are also higher with someone going for a vbac than for a birth where there has been no previous section. This makes the cs 'vs' vb issues different for someone considering a vbac.

Bigbella, I'm sure obstetricians can deliver babies, I just don't think doctors in general can.
I'm sorry it sounds as if you had a bad experience with your midwives - if they were slow in recognising that you needed medical help, they weren't doing their jobs very well.
I had a wonderful homebirth with ds, but I was only able to do it because I had complete faith that the two midwives who were present would pick up any problems at an early stage and send me into hospital for medical intervention if it was necessary.
Although I would never choose it for myself, I think women should be able to choose elective c-section on the nhs, in the same way they should be able to choose a homebirth, or a birth in a mlu, or to have an epidural, after being given full information about the risks of each option. Its our bodies and our babies that are at risk, so it should be our choice.

csection I just wish that the same level of care and individual attention was available to all women for each birth.

Personally I don't believe that CS should be offered as a straight choice in all cases due various issues including financial considerations to the NHS.

However I do believe that each woman should have her case looked at indivudually, and if there are reasons that for her a natural birth is not something that she wants, serious consideration should be given to offering a section. As in your case, it is totally understandable why you want a CS and IMO it would be cruel to say that you had to have a vaginal birth.

Luckily as far as I can see in most cases this is the way it is done on the NHS already.

Gaby I was told that the risks for VBAC were the same as for first time birth. So if there are no problems, surely the same logic should apply as for first time births.

Midwives and health visitors have a different role to paediatrians or obstetricians. They have a far more holistic and caring role, where as doctors are more interested in the mechanics.

Women are more than robots and they need their emotional needs cared for as well as their physical needs. Infact a lot of medical problems happen when the emotional needs aren't looked after. Giving birth is as much a mental activity as a physical activity. In an ideal world women would have domino care.

Their community midwife would go to the hospital with them if they chose not to give birth at home. The community midwife would either deliver the baby in hospital or act as a doula if the woman needed a c -section. Unfortunately this would cost more in the short term and require substantially more midwives.

It doesn't upset me women have elective c -sections. It does upset me women suffering post traumatic stress because of appauling care.

csectionthistime your consultant sounds lovely. Thats just how every woman should be treated - with respect for her choices. I know how stressful it can be to have to 'firm yourself up for a struggle', because I had to do that to get my homebirth.

I would be terrified of the thought of a c section. And very upset if it was forced on me because they didn't have the right staff/funds to give me a vb. So in good faith regardless of which costs more or uses less staff I wont force someone to do something they are frightened of be it natural or c section. I wouldn't like my birth choice of a vb taken away if it cost more so why should I say they should take the option of c section away as it does cost more. There are complications while pg that would make it safer for me to have a section but no one would argue the risks to my child/mother if I then choose a vb.

"Gaby I was told that the risks for VBAC were the same as for first time birth."

The risk of a uterine rupture in a mother who has no previous surgery to the uterus is about 1 in 16000.

The risk of a rupture to the uterus in a vbac mums is.... 1 in 200? Or is it 1 in 500? (depending on various things).

The rate of emergency c-section among mothers going for a vaginal birth with no previous c-section is about..... again, not sure actually, as the national 14% emergency c-section rate is made up of all women, not just women who've not had previous surgery. The rate of success for women going for a vbac varies hugely, depending on the reason for the previous section.

Women whose first section is for breech have about an 80% chance of succeeding to birth their babies vaginally afterwards.

Women who have a c-section for failure to progress or for cephalo pelvic disproportion have lower rates of success - around 50 - 60% I think. Anyway, much, much lower than multips expecting a second vaginal birth.

I should have specified that the risk of death to the baby is the same with vbac as it is with a first time vaginal delivery, apparently.

I was told that about 30% of vbacs are sucessful, which seem like quite good odds. Not sure what the success rate is for first time vaginal delivery, will look it up for my trust...

Last year about 25% of all births ended up in a CS, but I can't extract the proportion which were first time deliveries unfortunately.

Makes no odds though really as whether you plan a CS or end up with one, you still get the CS.

i still don't see why women are given the choice 2nd time if they're not allowed it first time. Surely the logic is the same.

As for teh risk of rupture - well there are risks associated with VB as well. Giving birth is not a risk free exercise whichever way you do it, and I still maintain that we are very lucky that in this country whichever way you do it, overall risks are very low.

gaby - I do understand why people wouldn't want to have a c-section. I wouldn't either, if I didn't have a first hand knowledge of the horrors of vaginal birth, and the very real prospect of another big episiotomy.

What I don't understand is the scaremongering re pain and recovery, especially coming from people who have never had an elCS. Two days on and I have no bandages and only a bit of pain during breastfeeding contractions. Last paracetamol I took was 10 pm last night and probably didn't even need to. I'm mobile, caring for baby, and feel great. There is no comparison to the gory hell of pain that was the aftermath of DD's birth. Oh and my lady bits are intact. What is not to like?

Cote my experience of emcs was the same as yours with elective.

Easy recovery, everything intact, very little pain, BF established easily.

Some people who have vaginal births have it easy and some have it terrible as well.

To say one way = bad and difficult and the other way = good and easy is too simplistic.

Each person and their experience are different - what is right for one is wrong for another.

congrats BTW cote, glad to see your section hasn't adversely affected your MNing

MNing from hospital bed while baby sleeps

Sure, experiences with both VB and CS vary widely. However I do feel there is unnecessary scaremongering about CS. You see it on MN on every thread where someone considers an elCS. So painful, such long recovery time, you can't pick up baby etc. All said with no 'maybe's but with certainty. Well, wrong on all counts, in my experience.